EMQ

EMQ — Extended Matching Question · Review

Question 231

Delivery suite → Haemorrhage

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Type EEMQ

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Placental abruption

Subtopic 3

Delivery

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 35-year-old G3P1 at 36+6 weeks presents with abrupt severe abdominal pain and vaginal bleeding. She is pale, pulse 126/min and blood pressure 94/58 mmHg despite initial intravenous fluid resuscitation. The uterus is tense and markedly tender. Continuous fetal monitoring shows persistent fetal bradycardia at 80 beats/min. Bedside ultrasound confirms a live cephalic fetus but does not demonstrate a retroplacental collection. The registrar proposes waiting for formal ultrasound confirmation of placental abruption before deciding whether delivery is necessary.

Answer Bank

A Await formal ultrasound confirmation before proceeding

B Expedite delivery while continuing maternal resuscitation

C Continue observation until the measured vaginal loss exceeds 500 mL

D Delay delivery until a repeat haemoglobin demonstrates a significant fall

E Manage expectantly because no retroplacental collection is visible

F Administer tocolysis and reassess fetal status after contractions settle

G Continue pregnancy because delivery before 37 weeks should be avoided

H Perform digital vaginal examination before deciding whether urgent delivery is required

Correct Answer

B. Expedite delivery while continuing maternal resuscitation

Explanation

The combination of maternal haemodynamic compromise, a tense tender uterus and persistent fetal bradycardia is strongly suggestive of severe placental abruption with maternal and fetal compromise. Maternal resuscitation remains paramount, but definitive obstetric management must proceed concurrently. Delivery should be expedited rather than delayed for formal ultrasound because abruption is principally a clinical diagnosis and a negative ultrasound does not exclude it.

Option Validity

A) Waiting for imaging confirmation risks dangerous delay in a clinical emergency.

C) Visible vaginal loss may substantially underestimate concealed haemorrhage.

D) Initial or repeat haemoglobin should not determine whether urgent delivery is required in a clinically compromised patient.

E) Absence of a sonographically visible retroplacental collection does not exclude abruption.

F) Tocolysis is inappropriate in the presence of significant maternal and fetal compromise.

G) The risks of ongoing severe abruption outweigh an arbitrary aim to reach 37 weeks.

H) Digital examination is not required before acting on maternal and fetal compromise.

Source & metrics

Authored Difficulty

4.00

Evaluation Score

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Destination

eBook

Source

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Source Section

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Updated

2026-10-06 01:57:35

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